拉米呋定与乙肝疫苗预防HBcAb阳性供肝儿童肝移植术后新发乙肝病毒感染效果的对照研究

A comparative study of the effect of lamivudine and hepatitis B vaccine on the prevention of de novo hepatitis B virus infection after liver transplantation in children with anti-HBc-positive liver grafts

目的比较拉米呋定与乙肝疫苗方案预防乙型肝炎核心抗体(hepatitis B core antibody,HBcAb)阳性供肝儿童肝移植术后新发乙型肝炎病毒(hepatitis B virus,HBV)感染效果。方法对天津市第一中心医院自2013年5月—2019年6月251例接受HBcAb阳性供肝儿童肝移植的资料进行回顾性分析,依据采用预防方案的不同分为拉米呋定组和乙肝疫苗组,对两组患儿的新发乙肝病毒感染情况以及临床资料进行比较分析。结果拉米呋定组45例和乙肝疫苗组206例,两组在供受者的临床特征方面无显著差异,两组的新发乙肝病毒感染例数分别为5例(11.1%)和10例(4.9%),发生率无显著统计意义(P=0.075),停用拉米呋定与新发乙肝存在关系。结论单用拉米呋定和乙肝疫苗均是有效预防HBcAb阳性供肝术后新发乙肝的方案,停用拉米呋定会增加新发乙肝的风险。

Objective To investigate the effect of Lamivudine and Hepatitis B Vaccine on preventing de novo hepatitis B virus(HBV)infection in recipients with anti-HBc-positive grafts in pediatric liver transplantation Methods A total number of 251 pediatric recipients receiving HBcAb positive grafts operated from May 2016 to December 2019 were retrospectively enrolled,Donor and recipient features along with graft and recipient outcomes were compared between recipients treated with Lamivudine and Hepatitis B Vaccine.Results Lamivudine group(45 cases)and Hepatitis B Vaccine Group(206 cases)showed no significant difference in clinical characteristics.The number of de novo hepatitis B virus infection was 5 cases(11.1%)and 10 cases(4.9%),respectively,the incidence was not statistically significant between two groups(P=0.075).There was a correlation between the discontinuation of Lamivudine and the de novo Hepatitis B.Conclusion Lamivudine alone and Hepatitis B vaccine are effective prophylactic strategies for preventing de novo HBV infection in pediatric liver transplantation recipients who receive hepatitis B core antibody(HBcAb)positive grafts.Discontinuing Lamivudine increases the risk of de novo hepatitis B virus infection.